1. Field of the Invention
The present invention relates generally to methods and devices designed to enhance the alignment of the upper quadrant of a user's kinetic chain. More particularly, the methods and devices of the present invention utilize the benefits of scapular retraction and stabilization technology. The result is a novel, alignment-improving device, and method of use, comprised of a brace for the sacral, lumbar, and lower thoracic regions of the spine and a brace for scapular retraction and stabilization.
2. Discussion of the Background
Spine and Posture Generally
Proper alignment of the upper torso is associated with reduced incidence of back and spinal maladies. The spine (or backbone) runs from the base of the skull to the pelvis. Health professionals describe a healthy spine as having three natural curves. First, there should be an inward or forward curve at the neck (known as the cervical curve). Secondly, there should be an outward or backward curve at the upper back (known as the thoracic curve). And third, a healthy back will have an inward curve at the lumbar region of the spine (the lumbar curve). These natural curves give the spine an “S” shape when viewed from the side, and help the spine withstand great amounts of stress by providing a more even distribution of body weight. Proper alignment helps to maintain these natural curves, whereas poor alignment does the opposite—which may cause pain and result in stress, pulled muscles, or back injury.
There are numerous salutary effects associated with proper posture. For example, good posture keeps bones and joints in the proper alignment. This ensures that muscles are used properly, thereby decreasing the risk of musculoskeletal injury. Proper alignment also decreases the abnormal deterioration of joint surfaces, which, if left untreated, often results in arthritis. In addition, good posture reduces stress on the vital ligaments which hold the joints of the spine together. Proper alignment also precludes the spine from becoming fixed in an unhealthy, unnatural position. Muscles, moreover, are used more efficiently when one has a properly aligned upper torso, which allows the body to exert less energy. Furthermore, proper alignment reduces back strain and problems associated with overuse, and can prevent backaches and muscular pains. Finally, proper posture enhances one's outward appearance and has been associated with a heightened sense of well-being.
The spine is divided into three regions. From top (neck) to bottom, those regions consist of the cervical spine, the thoracic spine, and the lumbar spine, respectively. The neck comprises the uppermost portion of the spine. The seven vertebrae within this region (the cervical spine) are numbered C1 to C7 (from top to bottom). As noted above, the first spinal curve is located at the cervical spine. It resembles a “C” as it bends slightly inward—forming the curve which is also known as a lordotic curve. The 12 vertebrae (T1 to T12) below the cervical spine comprise the thoracic spine (within the chest section), to which the ribs attach. The thoracic spine provides the second spinal curve as it bends outward (like a backward “C”). This curve is termed the kyphotic curve. Next is the Lumbar spine (e.g. the lower back), consisting of five vertebrae (L1 to L5). Some individuals also have a sixth lumbar vertebra (L6). The lumbar spine has more than one vital function. Composed of the largest vertebrae, the lumbar spine interconnects the thoracic spine and the pelvis and supports the majority of the body's weight. Like the cervical spine, the lumbar spine also curves inward (creating a second lordotic curve) Immediately below the lumbar spine is a large bone known as the sacrum. The sacrum forms the base of the spine and the rear of the pelvis. The sacrum terminates at a small bone called the coccyx (or tailbone).
Role of the Scapula
Among the constellation of bones comprising the “upper extremity” of the human body is the shoulder girdle, which itself consists of the clavicle and scapula (or shoulder blade bone). The scapula is a large, flat, triangular bone, located at the rear of the rib cage at an upper left border. The scapula is capable of movement in several directions. Upwards (elevation) and downwards (depression), forwards (protraction) and backwards (retraction), in addition to circumduction (pivoting upward and outward or inward and downward over the posterior of the rib cage). Several muscles control these scapular movements, including the trapezius, pectoralis major and minor, and the rhomboids.
The scapula is an essential part of normal shoulder function. The scapulothoracic articulation accounts for approximately 30% of all shoulder motion, with the remaining 70% provided by the glenohumeral joint. There are 17 muscular attachments to the scapula. These muscles bring about complex movements of the scapula, including: elevation, depression, protraction, retraction, lateral rotation, medial rotation, upward rotation, downward rotation, anterior tipping, and posterior tipping. These movements demonstrate the complex nature of neuromuscular control of the scapula.
The scapula performs many roles, including glenohumeral articulation, facilitating movement along the thoracic wall, elevating the acromion (during overhead activities to clear the acromion from the moving rotator cuff) to avoid impingement and compression, and providing a critical link in the proximal to distal sequencing for shoulder function.
The scapula is pivotal in transferring significant forces and substantial energy from the legs, back, and trunk to the delivery point (the arm and hand), thereby allowing more force to be generated in activities such as throwing (than could be done by the arm musculature alone).
Scapular dyskinesia is the loss of normal scapular motion and mechanics. It is associated with numerous shoulder pathologies, including instability, labial tears, and rotator cuff disease. It is also associated with non-shoulder pathologies, such as excessive thoracic kyphosis, anterior chest contracture, nerve damage, and micro trauma. Although scapular dyskinesia is a known generator of shoulder pain and dysfunction, it is at best poorly understood or overlooked by most practitioners. Few health care providers have a functional grasp of this complex problem, and resources and modalities are limited to provide adequate treatment.
Scapular Stabilization
Existing and ongoing research indicates that proper positioning and dynamic stabilization of the scapula provides effective treatment for numerous maladies associated with the upper extremities (including the neck, shoulder, and upper trunk). At present, a rapidly expanding body of literature shows a correlation between abnormal scapular function (e.g. “scapular kinematics”) and a variety of shoulder pathologies. (See J Orthop Sports Phys Ther. 2009 February 39(2): 90-104). Specifically, research now demonstrates a link between adverse scapular kinematic changes and shoulder impingement, rotator cuff tendinopathy, rotator cuff tears, glenohumoral instability, adhesive capsulitis, and stiff shoulders. Patients exhibiting these adverse scapular kinematic changes frequently suffer from reduced or altered functioning of the muscles that control scapula movement. For example, these patients often display reduced serratus anterior function and increased upper trapezius activation. In addition, scapular kinematic alterations often correlate with disfavored physiological conditions such as shortened rest length of the pectoralis minor, tight posterior shoulder, thoracic kyphosis, and flexed thoracic postures. All of the above pathologies emphasize the clinical and physiological importance of proper scapular positioning and stabilization. Despite this existing body of research, the science of scapular stabilization continues to evolve. Thus, current findings demonstrate the need for further investigation and for improved scapular stabilization devices that are capable of improving posture and ameliorating abnormal scapular kinematics.
Lumbar-Sacral Support, LSO Braces, and the Kinetic Chain
Scapular stabilization devices provide little or no support for the lumbar-sacral and lower thoracic region of the spine (e.g. the “lower back”). Lumbar sacral support reduces the load on the back muscles, and can be invaluable during episodes of acute and chronic lower back pain. Currently, patients in need of lower back support frequently turn to Lumbar-Sacral (“LSO”) braces or other braces designed to support and/or stabilize the sacral, lumbar and lower thoracic region of the spine. Typically, LSO braces are indicated for Failed Lower Lumbar Surgery Syndrome, chronic low back pain, multiple level decompression, radiculopathy, and spinal stenosis, among other disorders. Common lower back braces encircle the lumbar-sacral region of the torso, and consist of anterior and posterior panels to provide rigid control of the spine/torso and enhance spinal alignment. When worn properly, LSO braces assist the patient's development of proper posture and muscle memory, thereby reducing the incidence of lower back pain and injury and improving spinal alignment.
Current LSO braces, however, do not address the need for scapular stabilization discussed above. Likewise, current scapular stabilization devices do not provide adequate lumbar-sacral support and stabilization. What is needed, therefore, is an improved orthopedic unit that combines the benefits of dynamic scapular stabilization with rigid control and support of the lumbar sacral region of the spine. The combination produces a synergistic—and not merely additive—effect. This appears to be due, at least in part, to the fact that the spine, scapula, and shoulder all comprise part of a common kinetic chain. Thus, spinal alignment has been shown to influence scapular position. Likewise, both scapular position and spinal alignment influence shoulder position. This kinetic chain, or dynamic interrelationship (between the spine, scapula, and shoulder), derives from at least two sources. First, there are numerous intermuscular connections between the spine, scapula, clavicle, and humerus. These muscular connections, therefore, exert functional control over the spine, scapula, and shoulder (relative to each other). Secondly, there is a well-recognized biomechanical model demonstrating integrated movement of the glenohumoral and scapulothoracic joints during scapular plane abduction (commonly termed “scapulohumeral rhythm”).
One important study further demonstrated the critical interrelationship between the spine and scapula (and shoulder). In the study, researchers correlated slouched posture (as evidenced by an anterior tilt of the thoracic spine) with decreased scapular range of motion and increased anterior tilt (of the scapula). (See Arch Phys med Rehabbil 1999; 80:945-50). Conversely, the study demonstrated that bringing the thoracic spine posterior (indicative of proper posture) creates a corresponding posterior tilt (of the scapula), which in turn enhances humeral head alignment with the labrum to properly align the upper torso. As result, the researchers were able to conclude that thoracic spine position significantly affects scapular kinematics, and that slouched posture is associated with decreased muscle force.